Hi everyone,
My dad is 54 years old and was diagnosed with CLL, Rai stage III. He has been taking acalabrutinib (Calquence) for approximately 3 months. I’m trying to understand whether his blood count trend can still be part of the expected response to treatment, or whether it warrants further evaluation.
Here are his CBC results over time:
Before starting acalabrutinib:
- Total WBC/TLC: 35.58 × 10³/µL
- Absolute lymphocyte count (ALC): 30.46 × 10³/µL
- Hemoglobin: 11.7 g/dL
- Platelets: 111 × 10³/µL
After approximately 1 month:
- Total WBC/TLC: 121.1 × 10³/µL
- ALC: 113.4 × 10³/µL
- Hemoglobin: 10.9 g/dL
- Platelets: 162 × 10³/µL
After approximately 3 months (latest report):
- Total WBC/TLC: 148.33 × 10³/µL
- ALC: 139.88 × 10³/µL
- Lymphocytes: 94.3%
- Hemoglobin: 11.3 g/dL
- Platelets: 184 × 10³/µL
- Absolute neutrophil count (ANC): 7.12 × 10³/µL
The peripheral smear mentions lymphoid cells, smudge cells and prolymphocytes, consistent with his known CLL.
His hemoglobin has improved slightly from the 1-month result, and his platelet count has increased. However, his WBC and ALC have continued to rise, including between months 1 and 3.
His latest blood chemistry results also showed:
- Creatinine: 1.33 mg/dL
- eGFR: 64 mL/min/1.73 m²
- Urea: 56.4 mg/dL
- Uric acid: 8.33 mg/dL
We understand that BTK inhibitors such as acalabrutinib can cause redistribution lymphocytosis, where lymphocytes move from tissues into the bloodstream after treatment begins. What I’m unsure about is whether a continued rise at around the 3-month mark, particularly to these levels, is something others have experienced.
For those who have taken acalabrutinib, or caregivers whose family members have:
Did your WBC/ALC continue rising for around 3 months before starting to fall?
How long did it take for your counts to begin decreasing or normalize?
Did your hematologist assess the overall response using other findings, such as lymph node or spleen size, symptoms, hemoglobin and platelets, rather than the WBC alone?
Is there anything you would specifically recommend asking his hematologist about with this trend?
We will discuss the latest results with his hematologist. I’m not looking to replace medical advice—just hoping to hear about other people’s experiences with the timeline of response to acalabrutinib.
Thank you for reading and for sharing your experiences.